Radiology Quiz No 1
A young boy presents with sudden abdominal pain for a duration of 2 days. He was also noted to have progressive abdominal distension and inability to open his bowel or pass flatus. The abdominal pain was progressively worsening and a day prior to admission he was noted to have vomitting. According to the mother he has always had difficulty in passing motion and would require frequent enemas and laxatives to help him open his bowels. He passes very hard stools and at a frequency of once every week. He has had previous episodes of colicky abdominal pain but resolves with laxatives or enemas. This is the first episode of such severe presentation. On examination, revealed a dehydrated, listless child. He had a lowish blood pressure and his plse rate was fast. His abdomen was grossly distended and tender but no evidence of peritonitis. It was resonant on percussion. Per rectal was of empty rectum. This are his abdominal Xray.
and his CT scan
Any takes?
July 31st, 2007 at 8:11 pm
**Scratches head**
The last four pictures are very beautiful, like air bubbles.
Anyway, all jokes aside, I pray that the boy is fine now.
August 2nd, 2007 at 7:45 am
Toxic megacolon?
though the history is not suggestive
August 2nd, 2007 at 2:00 pm
Hirschsprung’s?
August 2nd, 2007 at 8:28 pm
Popped over from Judy’s and was suprised to stumble into an ER! Interesting…will come back and check for the prognosis.
August 3rd, 2007 at 6:25 am
Ouch…. how did the colon rupture?! *(or is it the intestines..)
August 5th, 2007 at 5:44 pm
Sorry I’m late. I just saw this.
Easy diagnosis on the plain x-ray & the CT scanogram.
SIGMOID VOLVULUS.
Coffee-bean sign on the plain x-ray & scano.
August 12th, 2007 at 9:29 am
Thanks vijay! Have more scans to come.
Yes, this child was being investigated for Hirscsprung disease but a week later while waiting for the rectal biopsies, presented with this — SIGMOID VOLVULUS. It was extremely dilated and was pending perforation. We sent the child over to the paediatric institute where all his investigations were ongoing.